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Smoking is defined by Healthofchildren (2020), as the inhalation of smoke by smoldering tobacco mostly used in three forms such as cigars, pipes, and cigarettes. The most preventable death in the United Kingdom is caused by smoking according to the World Health Organization (WHO 2005). The purpose of this assignment is to discuss statistics, the impact on health of the patients and others caused by passive smoking, interventions, and the effect on NHS, environmental, economic, and social factors at a national level.

In England, roughly two million people quit smoking by 2018 contrasting 2011 and the smoking prevalence in adults is persisting to decrease and reached 14.4% in 2018 in comparison with 14.9% in 2017 which represents a decline of nearly 175,000 people and 19.8% in 2013 (Selbie, 2018).

The Office for National Statistics (ONS 2018), and Public Health England (PHE 2019), indicate that adult smoking behavior in the UK has changed taking the expected smokers figure to an estimated 6 million in England. The greatest decrease in smoking prevalence is among people aged between 18 to 24-year-old, attaining 17.8% in 2017 contrasted with 25.7% in 2011. People of ages 25 to 34-year-old, remain of specific concern as in spite of attempts to reduce differences, the rates persist in the top ratio at 19.7% of existing smokers while people of age 65 and above stay on at the lowest prevalence rate of 8.1% representing almost 914,000 people.

Smoking behaviors are influenced by many factors. The environment of habitation, and neighborhood influence smoking behaviors. Besides, socio-economic factors are important in smoking behaviors. According to Moor et al. (2015; p. 462) and PHE (2019) statistics, people from low-income families were more likely to smoke where one in four are smokers, than those from more affluent backgrounds where one in ten people smoke, out of work people are prone to smoke nearly twice as individuals who work and smoking prevalence in people with a serious psychological disorder is mainly two and a half times higher than the nationwide average. Many social factors affect the tendency towards smoking but family factors such as the relationship between teens and their parents and the satisfaction they have in schools affect their tendency towards smoking (Bjerregaard and Larsen, 2018; p. 5).

Also, there are social impacts of tobacco smoking on both active smokers and their close circle of family and friends, in teenagers, for instance, the onset of cigarette smoking is encouraged or discouraged by the type of neighborhoods surrounding teenagers (Cambron et al., 2018; p. 374).

Allender et al (2009), state that smoking has a health burden on the smoker both in the short-run and in the long run causing severe illnesses and some can be fatal. Smoking causes over fifty diseases such as stroke, cancer, chronic obstructive pulmonary disease (COPD), and heart disease, plus nearly every organ of the body is damaged triggering a decrease in quality of life and life expectancy (Ewles, 2005). Smoking has been identified by Cho et al. (2016, p. 112), as a risk factor in the development of dementia and as well as the associated decline in the cognitive function of the victims.

In a study by Cho et al. (2016, p.114), 977 participants were sorted into three categories based on their history of smoking. It was identified that cognitive function declined when the length of smoking was used as a continuous variable. Besides, smoking has particular impacts on coronary heart ailments. In a study that used over 25 cohorts in a Cox regression analysis and over 50,000 participants, over 75% of the participants died from coronary heart diseases caused by prolonged smoking (Mons et al., 2015; p. 1551).

Smoking impacts the recovery of patients after undergoing treatments such as surgery. It was found that smokers had a higher rate of postoperative complications than non-smokers (Schmid et al., 2015; p. 223). Complications such as premature birth, stillbirth, a low birth weight baby, or even miscarriages are caused by smoking during pregnancy and put the mothers health at risk as well as the health of the unborn baby. To illustrate the impact of smoking on passive smokers, studies on the exposure to tobacco smoke of pregnant women have been conducted with interesting results. In one study, pregnant women were screened using the cotinine test of their saliva coupled with a personal declaration of exposure to tobacco smoke (Salihu et al., 2015; p.205). The research identified that although the expectant mothers were not active smokers, passive exposure to tobacco is lethal to the developing fetus.

Public Health England (PHE, 2019) reveals that on average 10 years of life are lost by smoking people and about 78,000 deaths occur yearly in the UK which symbolizes 16% of mortalities are caused by smoking. NHS and the wider economy and society are also substantially affected by smoking. According to the Office for National Statistics (ONS, 2018), around 485,000 hospital admissions due to smoking-related diseases were assessed in England in 2016 and 2017, with the total cost reaching £851.6 million. In 2010/2011 in England were dispensed 2.56 million prescriptions compared to 0.86 million in 2017/2018, with a cost estimate of £144.8 million. In 2015 the cost of NHS to smoking-related care was a total of £2.6 billion, from which £1.1 billion was for primary care according to GOV.UK (2017).

Due to the increased number of smoking people, in England a smoking ban was introduced as the effect of the Health Act 2006, making it illegal to smoke in all sheltered places all over the country, and came into force on 1 July 2007 (GOV.UK, 2015). More rules and regulations regarding smoking, and tobacco end e-cigarettes followed to help decrease the number of smoking people and to protect children and young people from being harmed (GOV.UK, 2015). For example, smoking in a private vehicle that is carrying a person under 18 years of age, but the same rule does not apply to e-cigarettes according to GOV.UK, (2015)

Feasible strategies include Nicotine Replacement Therapy (NRT) where smokers are encouraged to slowly quit smoking by consuming nicotine through other ways (chewing gum and inhalers) other than smoking (NHS, 2019). There are medications such as varenicline, and bupropion that removes the craving withdrawal symptoms related to stopping smoking. E-cigarettes have also been used to help quit smoking with better results posted than patches and gums (NHS, 2019). In recent years, there have emerged behavioral support programs that minimize the desire to smoke. Other methods include education, training, and campaigns NICE, (2018).

Smoking is a public health concern because not only active smokers get affected by tobacco smoke but also non-smokers who are exposed to smoking through a range of risk factors including passive smoking and air pollution. Therefore, the importance of the joint obligation that the smoker has toward society is undeniable. Consequently, advising smokers and supporting them to quit and avert them to exhibit their smoking habits in public is essential.

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